Type A Aortic Dissection Repair at High Versus Low Volume Centers
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Background
Studies have shown significant improvement in outcomes when ATAAD repairs are performed at high-volume centers, with both center and surgeon volumes contributing to improved survival. The aim of our study was to evaluate our own network and determine differences in ATAAD outcomes between our high- and low-volume aortic centers.
Methods
This was an observational, multi-center retrospective study consisting of 205 cases of ATAAD repair within our institution, consisting of 3 hospitals within the region that perform cardiac surgery, from January 2017 to January 2025. Preoperative characteristics, operative characteristics, and postoperative outcomes were collected, stratified by center volume (high vs low) and analyzed.
Results
There were 205 patients identified with ATAAD who presented to our health network. Of these, 164 presented to our high-volume center while 41 presented to our low volume centers. When stratified by center volume, there was no significant difference in preoperative characteristics. What was significant were the cardiopulmonary bypass (CPB) [174 (137-218) versus 236.5 (195.5-288) minutes, p <0.001], circulatory arrest [30 (22-45) versus 45 (33-67) minutes, p=0.001], and cross clamp times [93 (72-127) versus 131 (94.5-194) minutes, p=0.002]. The univariable, survival analysis did show a significant difference in survival at 3 years – 81.5% versus 66.7% [p=0.009]. Utilizing a multivariable Cox regression model, having surgery at a high-volume center was found to be associated with a significant difference in 3-year survival [p=0.021].
Conclusion
Time from presentation to surgery influences mortality, but overall mortality has been shown to be much more dependent on where the repair is performed.
Central Message
Studies, including our own, have shown significant improvement in outcomes when dissection repair is performed at high-volume centers because of technical innovations and multi-disciplinary expertise.
Perspective Statement
A regional care model with emphasis on diagnosis and treatment protocols has been shown to reduce times to diagnosis and treatment, with both center and surgeon volumes contributing to improved aortic dissection survival. The aim of our study was to evaluate our own network and determine differences in acute type A aortic dissection outcomes between our high- and low-volume aortic centers.
